i njury m aintenance. w hat to do once an injury occurs ? create a medical form including everything...
TRANSCRIPT
WHAT TO DO ONCE AN INJURY OCCURS?
Create a medical form including everything you think needs to be included in an injury report.
TYPES OF INJURIES
Closed (Unexposed) Wounds Closed soft tissue:
Contusion Sprain Strain
Bone and Joint Articulation (a union between two bones): Closed Fx- Simple (no disruption of skin surface) Traumatic (acute) Fx- Immediate pain, rapid swelling,
bony tenderness, crepitus, with movement of bony fragments and possible deformity if fx is displaced
Stress Fx- onset of pain is gradual, pain or deep ache at first noticeable only during activity, may subside with rest, progressing to more constant pain if offending injury continues
BONE AND JOINT ARTICULATION INJURIES CONT…
Epiphyseal Injury – disruption or separation of the epiphysis or epiphyseal plate (Salter-Harris Fx)
Dislocation- complete disassociation of two joint surfaces
Subluxation – incomplete disassociation of two joint surfaces (may be difficult to identify)
Nerve Injuries Neuralgia- achiness or pain along a nerve secondary to
chronic irritation or inflammation Neuroma – thickening of a nerve or “nerve tumor”
secondary to chronic irritation or inflammation
OPEN (EXPOSED) WOUNDS Open wounds – injuries that involve a disruption in the
continuity of the skin caused by friction or by blunt or sharp trauma Abrasion – “Strawberry” large surface area exposed, caused by
friction Blister – separation and accumulation of fluid or blood between
superficial skin layers secondary to repetitive friction or shearing movements
Incision – a cut through all layers of the skin by a sharp object or instrument (smooth, even wound edges)
Laceration – a tearing of the skin by blunt trauma to the skin over a bony prominence, (jagged, uneven wound edges)
Puncture – a small disruption in the skin caused by sharp penetrating object
Avulsion – a tearing off or complete disassociation of a portion of skin
Compound fx/dislocation- disruption of the skin surface secondary to penetration by a displaced fx fragment or joint dislocation (Fx = Fracture)
PRINCIPLES OF EXAMINATION
Assessment – a procedure through which the clinician determines the severity, irritability, nature and stage of an injury
Evaluation – is the systematic process that allows the clinician to make a clinical judgment
Primary Survey- ABCs Secondary Survey- rapid examination of the
seriousness of the injury before the athlete is moved
STAGES OF ASSESSMENT SOAP Notes
Subjective Objective Assessment Plan
Subjective = history Severity, irritability, nature of the injury, MOI, only as good as
the questions you ask What questions should be asked?
Objective = tests Comparable sign= reproducing the problem Bilateral Comparison Observation Palpation Range of Motion (ROM) Strength Special Tests (any body know any tests?) Neurological Status Vascular Status Functional Testing
FUNCTIONAL TESTING LOWER BODY Balance in standing (Stork or tandem stand) Walking forward Walking up and down stairs (practicality?) Jogging Forward Running Forward Sprinting Forward Hopping Forward Jogging, running, sprinting backward Jogging, running, sprinting side to side Hopping alternate feet Hopping involved leg only Skipping forward and backward, side to side Jumping forward, backward Sport Specific Activities
FUNCTIONAL TESTING UPPER EXTREMITY
Tossing Throwing Pitching Hitting Batting Catching Receiving Standing on hands Supporting body weight on arms Sport Specific Activities Anything else?
Chief Complaint- what’s wrong?, where does it hurt?, what happened?
Mechanism of Injury (MOI)- how the injury occurred Compressive force Tensioning force Twisting force Shearing force
Nature of illness or injury Events surrounding the injury
TAKING A HISTORY
ACUTE HISTORY QUESTIONS What happened and how
did it happen? What position were you
in when the injury happened? (How they landed)
Did you hear or feel any unusual sounds or sensations at the time of injury? (snap, pop, or click)
Do you feel any unusual sensations now? (numbness, tingling, burning)
Where is the pain? Point with one finger
Can you describe the pain? Quality of pain (Sharp, dull,
achy) Intensity (Pain scale 0-10) Localized or diffuse Referral of pain to other
segments Changes in pain from when
it started (intensified or lessened)
When does it hurt? What is the previous
history? What is the previous hx for
the opposite side? Are there any other
medical conditions to be aware of?
NONACUTE HISTORY QUESTIONS
What happened and how? (did it come on gradually and when did they appear)
What activities aggravate the injury now?
What makes it feel better?
When you work out, when do the symptoms come on and for how long?
Do the symptoms interfere with daily activities, and if so, what activities?
Can you describe the pain? Quality of pain (sharp, dull,
achy) Intensity (0-10 scale) Localized or diffuse Referral to other segments Changes in pain from when it
started (intensified or lessened over time)
Does the pain wake you up at night?
Is there anytime during the day that the pain is worse or less or is the pain activity related?
What treatments if any have you self-administered?
CHRONIC HISTORY What hurts? When did this occur? Was it sudden onset or
gradual? Can you describe the pain? When does it hurt? Is the pain constant or
intermittent? How long does the pain last? What makes it worse? Have you made any abrupt
or significant changes in training? Change in intensity, duration,
training surface, type of activity
Change in training implements
Shoes, rackets, bat grips, etc.
What is the previous hx for the body region?
Are there any medical conditions to be aware of? Change in diet or weight? Recent illness? Other signs and symptoms? Existing medical conditions? Taking any medications or
receiving treatment?
OBSERVATION Initial/overall
impression on the field/clinical setting
Observation of body type Ectomorph- low to
normal body fat, low muscle mass (underweight)
Mesomorph – low to normal body fat, high muscle mass
Endomorph – high fat and muscle mass and is overweight
Observation of Posture and Gait
Observation of Injured Segment
What would you be looking for?
PALPATION
Need anatomical knowledge
Personal skills Keep patient
comfortable
Technique Rolling and strumming Movement when
palpating still structures Stillness when palpating
moving structures Movement of a limb as
a palpation tool
Structures to palpate Skin
Use back of hand to palpate for moisture and temperature
Fascia Superficial fascia has spongy soft
end feel (when moving skin the resistance you feel is superficial fascia)
Muscle Bone Joint Structures Neurovascular Tissue Lymph Nodes
PALPABLE BONY STRUCTURES Shaft- body of a long bone Head or condyle – rounded
end of a long bone that articulates with the joint
Epicondyle – the prominent aspect of the bone, proximal to the condyle
Groove – a narrow, longitudinal depression in a bone (passage for a tendon)
Ridge or crest – raised surface on bone
Tubercle – small and rounded projection
Tuberosity – A more prominent and large rounded projection
Apophysis – A small projection on a bone that serves as the attachment for a tendon
Epiphyseal Plate – area of growth between shart and end of bone
Notch – indentation in the end of a bone (ligaments, nerves, arteries, tendon)
PALPABLE JOINT STRUCTURES Synovial Capsule – a
well-defined membranous connective tissue that surrounds and encloses the structures of a synovial joint
Articular Cartilage – smooth, cartilage that covers the articular surface of a bone
Bursa - fluid filled sac that contains synovium to reduce friction between structures
Joint Line – a palpable separation between two articulating bones
Ligament – a taut, cordlike or bandlike fibrous connective tissue that connects bone to bone
RANGE OF MOTION
Range of Motion – the arc of motion through which a segment moves Active ROM Passive ROM Resistive ROM
1-5 Grading Scale
Goniometer – measuring tool for ROM
PRACTICE ROM
With a partner practice moving them through PROM Shoulder
flex/ext/abd/add/int/ext rot
Knee flex/ext Elbow flex/ext Pronation/Supination
Calculate using the Goniometer their ROM in each direction
SPECIAL TESTS
Each injury may or may not have specific special tests that can be used to identify that injury.